Title: Pharmacist Resume Quota - 1 per opening Remote - EST The position is scheduled for M onday through Friday, 10:00 AM to 6:00 PM, with a potential Saturday rotation based on business needs. Please note that the shift schedule may also be adjusted in the future to meet operational demands. Candidates must hold an active pharmacist license in good standing in any of the 50 U.
S. states. Duties:As a licensed healthcare professional employed in the Prior Authorization Department the primary responsibility of Pharmacist (R) is to make determinations on prior authorization requests for coverage of pharmaceutical products. Determinations include medical necessity and benefit decisions.
Decisions are made in accordance with established pharmacy guidelines, prior authorization criteria, industry regulations and sound clinical judgment. Prior Authorization Pharmacist (R) works independently with respect to reviews and decision making, with the support of Pharmacist II (R)s and supervisors. Pharmacist (R) works as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.
This position includes a rotating weekend schedule if business needs dictate. Additional responsibilities include:Provide clinical support to the PerformRx Customer Care CenterEngage providers in discussions to support determinationsSupport Fraud and Abuse program oversightKeep abreast of industry trends and regulatory changesKeep abreast of operational directives and customer reference materialsSkills:No experience required, Prior Authorization or Coverage Determination experience preferred Proficient PC skills in a Windows based environment#AlliedTech1